Treatment of conjunctival squamous cell carcinoma with topical 5-fluorouracil.

AIM: To evaluate the efficacy of topical 5-fluorouracil (5-FU) alone, without concurrent surgery or radiotherapy, for the treatment of conjunctival squamous cell carcinoma. METHODS: Eight patients affected by conjunctival squamous cell carcinoma (three recurrent cases, three incompletely excised, and two untreated cases) were treated with 1% 5-FU eye drops. Topical 1% 5-FU was administered four times daily for 4 weeks (one course). Clinical examination (biomicroscopy and photography) and morphological evaluation of conjunctival cytological specimens were used to monitor the efficacy of local chemotherapy, side effects, and recurrences. RESULTS: All patients showed clinical regression of conjunctival carcinoma after topical 1% 5-FU treatment. Neoplastic conjunctiva was completely replaced by normal epithelium within 3 months. Mean follow up was 27 months. One patient needed two courses of local chemotherapy for recurrent disease. An acute transient toxic keratoconjunctivitis was observed in all treated cases; it was easily controlled with topical therapy. No long term side effects were found. CONCLUSIONS: Topical 1% 5-FU is effective in the treatment of recurrent, incompletely excised, and selected untreated conjunctival squamous cell carcinomas. Topical 1% 5-FU has no major complications. This study suggests that topical conjunctival chemotherapy with 1% 5-FU may be useful, at least as adjunctive therapy, in the treatment of conjunctival squamous cell carcinoma.

Histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto disease) diagnosed by fine needle aspiration biopsy.

A case of histiocytic necrotizing lymphadenitis involving a right submandibular lymph node is described in a 14-year-old Caucasian boy. The diagnosis was established on initial assessment by fine needle aspiration biopsy. Excisional biopsy, performed because the lymph node enlargement failed to regress, confirmed the cytological findings.

Kimura's disease of the intraparotid lymph nodes: fine needle aspiration biopsy findings.

A case of Kimura's disease involving two intraparotid lymph nodes is described in a 16-year-old Caucasian boy presenting with a painless swelling of the right parotid gland. A preoperative diagnosis of Kimura's disease was made on the basis of fine-needle aspiration biopsy (FNAB) and was confirmed by histological evaluation of the surgical specimen. FNAB is a safe and accurate procedure that can be used in the outpatient setting to enable a prompt preliminary diagnosis.

Hyalinizing clear cell carcinoma of the oral cavity and of the parotid gland.

Hyalinizing clear cell carcinoma (HCCC) is a rare, recently described tumor of salivary gland origin. Differential diagnosis includes benign lesions as clear cell change in a pleomorphic adenoma or in oncocytoma and malignant tumors - i.e. epithelial-myoepithelial carcinoma, polymorphous low-grade adenocarcinoma, mucoepidermoid carcinoma, clear cell acinic carcinoma, clear cell squamous carcinoma, clear cell malignant melanoma, clear cell odontogenic carcinoma, clear cell rhabdomyosarcoma, sebaceous carcinoma and metastasis of renal carcinoma. A favorable prognosis after wide local excision has been evidenced. Three new cases of HCCC (2 in the oral cavity and 1 in the parotid gland) are presented.

Fine needle aspiration biopsy of salivary gland lesions. A reappraisal of pitfalls and problems.

OBJECTIVE: To assess the diagnostic value of fine needle aspiration biopsy in individual lesions of the salivary glands. STUDY DESIGN: During a 16-year period (1979-1995), 841 salivary gland lesions were investigated by fine needle aspiration with cytologic examination. The lesions affected the parotid gland area in all cases except 85 and 19, respectively, in which the submandibular gland and oral cavity (more often the palate) were involved. RESULTS: Approximately 3% (25/841) of the aspirates were inadequate, and in 97% of cases they represented the result of samplings performed outside our institution. The 816 diagnostic aspirates comprised 245 cases negative for tumor cells (benign cysts, inflammatory, malformed, degenerative lesions), 571 positive for tumor cells (benign; malignant; not otherwise specified [NOS]); metastatic to the salivary gland tissue; or to the intraparotid or periparotid lymph nodes). Among the 245 cases negative for tumor cells, 36 underwent surgery, and the absence of a neoplasm was histologically confirmed in all cases but one (a low grade mucoepidermoid carcinoma, underdiagnosed as a retention cyst). Among the 571 patients having a cytologic diagnosis positive for tumor cells, in 518 the lesion was removed and the tumor nature confirmed. The cytologic diagnosis of a neoplastic lesion demonstrated a good correlation with histology except in an oncocytic adenoma diagnosed as a Warthin's tumor, in a basal cell adenoma diagnosed as pleomorphic adenoma, in a low grade mucoepidermoid carcinoma of the palate diagnosed as a polymorphous low grade adenocarcinoma and in a vegetative intravascular hemangioendothelioma diagnosed as a possible malignant tumor, NOS. CONCLUSION: The accuracy was 97%, the sensitivity to the presence of a tumor 98% and the specificity for absence of a neoplasm 98%. Despite the relative rarity of salivary gland tumors, if established diagnostic criteria are present and strictly observed, the great majority of the common variants of the nonneoplastic and both benign and malignant salivary gland tumors can be diagnosed with a high level of accuracy. There remains a proportion of "problem cases" due to the rarity of the lesions, and in these circumstances the uncertainty must be conveyed to the surgeon openly, leaving the diagnosis open, with a few suggested differential diagnoses.

A simple exam to screen superficial masses: fine-needle aspiration cytology.

Fine-needle aspiration cytology (FNAC) is now considered a useful tool in the evaluation of adult patients with mass lesions. We reviewed the experience with FNAC in our Paediatric Surgical Department. One hundred and eleven FNACs were performed in children with a superficial mass and no definite diagnosis. All the exams were done by the same physician using a fine needle and no anesthesia. We routinely used May-Grüwald-Giemsa and Papanicolaou staining. Patients age ranged from 20 days to 17 years, with a mean age of 6.5 years. A clinically benign pathology was cytologically confirmed in 90 cases (81%). All children did well at follow-up. Malignancy was diagnosed in eight cases (7.2%) and in all was confirmed with a surgical biopsy. In nine children (8.1%) the specimen was considered insufficient for definite diagnosis. In four cases (3.6%) the pathologist diagnosed a possible malignancy that was excluded at surgical biopsy. The sensitivity was 100% and the specificity was 96%. Our experience confirms that FNAC is a fast, cheap, simple, and accurate diagnostic method and should be used for screening in all children with doubtful superficial masses.

Intraoperative cytology of pancreatic masses. A 10-year experience.

The results of intraoperative fine needle aspiration biopsy (FNAB) of 92 pancreatic masses (1982-1992) are reported. The high sensitivity (1.00) and specificity (1.00) values are believed to be due to the presence of a cytopathologist in the operating room. The cytopathologist assesses the adequacy of the sampled material and, using rapid staining, can make a cytologic intraoperative diagnosis. This procedure led to the diagnosis of inflammatory lesions and of common and rare pancreatic neoplasms in a few minutes. Emphasis is laid on the characteristics of pancreatic FNAB vs. the more invasive procedures (e.g., wedge biopsies).

[Primary mesothelioma of the pericardium: diagnostic methods. A case report]. / Mesotelioma primitivo del pericardio: metodi diagnostici. Descrizione di un caso.

Clinical picture and diagnostic methods in a patient with primary pericardial mesothelioma are described. Echocardiography shows an intrapericardial mass in direct continuity with left ventricular wall. Magnetic resonance imaging is essential to define mass dimension and extension and show cardiac wall and contiguous tissues infiltration. The histological characteristics are defined by using TAC-guided needle biopsy and needle aspiration.

Spontaneous regression of subcutaneous metastasis of cutaneous melanoma.

A case is presented of a 44-year-old Caucasian man who was operated on in October of 1988 for a cutaneous melanoma in his trunk and who in the space of 1 year manifested a single subcutaneous nodule compatible with a metastasis of melanoma by fine-needle aspiration biopsy. No other abnormal findings were revealed by physical and instrumental examinations. During the subsequent hospitalization, we witnessed (in conjunction with the occurrence of painful symptoms in the hands of an inflammatory nature) the total, progressive, spontaneous regression of the metastasis, which was confirmed by the clinic and the tests. After 15 months of follow-up, the patient has not shown any further signs of illness.

Orbital ectopic lacrimal gland tissue simulating a neoplasm. Report of a case with fine needle aspiration biopsy diagnosis.

A case occurred of sclerosing chronic dacryoadenitis in lobules of ectopic lacrimal gland tissue diagnosed by fine needle aspiration biopsy performed under computed tomographic guidance. This choristomatous lesion caused unilateral proptosis and clinically simulated a neoplasm. This is the first report of cytologic diagnosis of orbital ectopic lacrimal gland tissue using fine needle aspiration biopsy. The potential hazard of regarding glandular inclusions derived from inadvertent use of a needle on a normal lacrimal gland or glands as indicating metastatic neoplasms is stressed.

[Adenomatoid tumor of the epididymis: cytologic diagnosis by fine-needle aspiration (FNA)]. / Tumore adenomatoide dell'epididimo: diagnostica citologica per aspirazione con ago sottile (FNA).

Adenomatoid tumor of the epididymis diagnosed using fine needle aspiration (FNA). The adenomatoid tumor of the male genital system is a relatively uncommon, well recognized neoplasm with benign histologic appearance, and mostly asymptomatic clinical features. We describe a case of adenomatoid tumor of the epididymis diagnosed before surgery by fine needle aspiration cytology (FNA). This diagnostic procedure has allowed a rapid, reliable, and conclusive surgical approach.

"Cyto-assisted", ultrasound-guided biopsy in the diagnosis of focal disease of the abdomen.

From May 1988 to June 1990, 260 patients with abdominal focal disease underwent ultrasonically guided percutaneous fine needle biopsy. The technique of so-called "FNAB-CYT" is described. The procedure entailed very few complications: the mortality rate was 0% and the morbidity rate was 1.5%. The specificity of the technique was 100%, and sensitivity was 93.43%. False-negative diagnoses were made in 8 cases, and in 5 patients the cytologic diagnoses were uncertain. There were no false-positives. The possibility of an immediate control of the collected material by the pathologist avoids the risk of inadequate samples and reduces the number of biopsies for the patient. Comparison among diagnoses on rapid and definitive preparations and histologic ones was carried out to evaluate the diagnostic efficiency of the cytologic procedure. In our experience, a rapid staining of the smears allowed a correct cytologic diagnosis in 87.7% of the cases within approximately 5 min of the biopsy. On the basis of our experience, the authors recommend FNAB-CYT as a routine first-level (less invasive) procedure for diagnosis of abdominal focal disease.

[Primary isolated lymphoma of the liver: rapid cytological diagnosis by fine needle aspiration biopsy]. / Linfoma primitivo isolato del fegato: diagnosi citologica "rapida" mediante FNAB.

A case of primary hepatic lymphoma diagnosed with rapid staining of smears of material collected with echo-guided FNAB is described. The primary isolated lymphoma of the liver is a rare disease and forty reported cases since 1989 have been reviewed in the literature; many of which were first diagnosed at autopsy or shortly before death. Due to the rarity of the primary hepatic lymphoma, a large list of differential diagnosis has to be considered and they all fall into the category of malignant small cell tumors: moreover a definitive diagnosis may be sometimes impossible in a small needle biopsy. In the reported case the importance of a unique morphological feature (lymphoglandular bodies) is discussed in order to stress the easier diagnosis of lymphoproliferative disease allowed on cytological preparations vs. histological ones.

[Lymph node metastases of a Merkel-cell tumor of unknown origin: possibilities and limitations of fine-needle aspiration cytology]. / Metastasi linfoghiandolare di tumore a cellule di Merkel a sede primitiva non nota: possibilità e limiti della diagnostica citologica per aspirazione con ago sottile (FNA).

The authors report a case of lymph node metastasis of a Merkel cell carcinoma with unknown primary localization. The definitive diagnosis was posed histologically since the FNA report was--in this case--only "coherent with a small malignant cells proliferation".